- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,271.78 / $2,271.78 / $18,681.90
| Professional | | $2,271.78 | $2,271.78 | $18,681.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,396.61 / $18,247.64 / $38,732.54
| Facility | | $7,396.61 | $18,247.64 | $38,732.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $13,032.93 / $19,773.81 / $34,671.62
| Facility | 50 | $13,032.93 | $19,773.81 | $34,671.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.39 / $3,079.72 / $9,562.90
| Professional | | $777.39 | $3,079.72 | $9,562.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,251.89 / $10,284.09 / $24,739.76
| Facility | | $7,251.89 | $10,284.09 | $24,739.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.15 / $2,748.75 / $11,856.64
| Professional | | $915.15 | $2,748.75 | $11,856.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,710.15 / $9,402.12 / $19,480.13
| Facility | | $5,710.15 | $9,402.12 | $19,480.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.08 / $3,837.01 / $10,301.25
| Professional | | $846.08 | $3,837.01 | $10,301.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.90 / $5,664.41 / $18,862.48
| Facility | | $698.90 | $5,664.41 | $18,862.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,167.20 / $7,531.56 / $14,811.18
| Professional | | $4,167.20 | $7,531.56 | $14,811.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,790.61 / $7,474.98 / $14,142.28
| Professional | | $3,790.61 | $7,474.98 | $14,142.28 |